Elad Anter1, Mattias Duytschaever2, Changyu Shen3, Teresa Strisciuglio2, Eran Leshem1, Fernando M Contreras-Valdes1, Jonathan W Waks1, Peter J Zimetbaum1, Kapil Kumar1, Peter S Spector4, Adam Lee5, Edward P Gerstenfeld5, Elad Nakar6, Meir Bar-Tal6, Alfred E Buxton1. 1. Cardiovascular Division, Department of Medicine, Harvard-Thorndike Electrophysiology Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (E.A., E.L., F.M.C.-V., J.W.W., P.J.Z., K.K., A.E.B.). 2. Department of Cardiology, Sint-Jan Hospital Bruges, Belgium (M.D., T.S.). 3. Division of Cardiovascular Medicine, Richard A. and Susan F. Smith Center for Cardiovascular Outcomes Research, Beth Israel Deaconess Medical Center, Boston, MA (C.S.). 4. University of Vermont College of Medicine, Burlington (P.S.S.). 5. Division of Cardiology, Section of Cardiac Electrophysiology and Arrhythmia Service, University of California, San Francisco (A.L., E.P.G.). 6. Biosense Webster, Johnson & Johnson, Research and Development Department, Yokneam, Israel (E.N., M.B.-T.).
Abstract
BACKGROUND: Activation mapping of scar-related atrial tachycardias (ATs) can be difficult to interpret because of inaccurate time annotation of complex electrograms and passive diastolic activity. We examined whether integration of a vector map can help to describe patterns of propagation to better explain the mechanism and location of ATs. METHODS: The investigational mapping algorithm calculates vectors and applies physiological constraints of electrical excitation in human atrial tissue to determine the arrhythmia source and circuit. Phase I consisted of retrospective evaluation in 35 patients with ATs. Phase II consisted of prospective validation in 20 patients with ATs. Macroreentry was defined as a continuous propagation in a circular path >30 mm; localized reentry was defined as a circular path ≤30 mm; a focal source had a centrifugal spread from a point source. RESULTS: In phase I, standard activation mapping identified 28 of 40 ATs (70%): 25 macroreentry and 3 focal tachycardias. In the remaining 12 ATs, the mechanism and location could not be identified by activation and required entrainment or empirical ablation for termination (radiofrequency time, 17.3±6.6 minutes). In comparison, the investigational algorithm identified 37 of 40 (92.5%) ATs, including 5 macroreentry, 3 localized reentry, and 1 focal AT not identified by standard mapping. It also predicted the successful termination site of all 37 of 40 ATs. In phase II, the investigational algorithm identified 12 macroreentry, 6 localized reentry, and 2 focal tachycardias that all terminated with limited ablation (3.2±1.7 minutes). It identified 3 macroreentry, 3 localized reentry, and 1 focal AT not well characterized by standard mapping. The diagnosis of localized reentry was supported by highly curved vectors, resetting with increasing curve and termination with limited ablation (22±6 s). CONCLUSIONS: Activation mapping integrating vectors can help determine the arrhythmia mechanism and identify its critical components. It has particular value for identifying complex macroreentrant circuits and for differentiating a focal source from a localized reentry.
BACKGROUND: Activation mapping of scar-related atrial tachycardias (ATs) can be difficult to interpret because of inaccurate time annotation of complex electrograms and passive diastolic activity. We examined whether integration of a vector map can help to describe patterns of propagation to better explain the mechanism and location of ATs. METHODS: The investigational mapping algorithm calculates vectors and applies physiological constraints of electrical excitation in human atrial tissue to determine the arrhythmia source and circuit. Phase I consisted of retrospective evaluation in 35 patients with ATs. Phase II consisted of prospective validation in 20 patients with ATs. Macroreentry was defined as a continuous propagation in a circular path >30 mm; localized reentry was defined as a circular path ≤30 mm; a focal source had a centrifugal spread from a point source. RESULTS: In phase I, standard activation mapping identified 28 of 40 ATs (70%): 25 macroreentry and 3 focal tachycardias. In the remaining 12 ATs, the mechanism and location could not be identified by activation and required entrainment or empirical ablation for termination (radiofrequency time, 17.3±6.6 minutes). In comparison, the investigational algorithm identified 37 of 40 (92.5%) ATs, including 5 macroreentry, 3 localized reentry, and 1 focal AT not identified by standard mapping. It also predicted the successful termination site of all 37 of 40 ATs. In phase II, the investigational algorithm identified 12 macroreentry, 6 localized reentry, and 2 focal tachycardias that all terminated with limited ablation (3.2±1.7 minutes). It identified 3 macroreentry, 3 localized reentry, and 1 focal AT not well characterized by standard mapping. The diagnosis of localized reentry was supported by highly curved vectors, resetting with increasing curve and termination with limited ablation (22±6 s). CONCLUSIONS: Activation mapping integrating vectors can help determine the arrhythmia mechanism and identify its critical components. It has particular value for identifying complex macroreentrant circuits and for differentiating a focal source from a localized reentry.
Authors: Caroline H Roney; John Whitaker; Iain Sim; Louisa O'Neill; Rahul K Mukherjee; Orod Razeghi; Edward J Vigmond; Matthew Wright; Mark D O'Neill; Steven E Williams; Steven A Niederer Journal: Comput Biol Med Date: 2018-11-01 Impact factor: 4.589
Authors: Vanessa Sciacca; Thomas Fink; Leonard Bergau; Guram Imnadze; Mustapha El Hamriti; Denise Guckel; Martin Braun; Moneeb Khalaph; Philipp Sommer; Christian Sohns Journal: J Clin Med Date: 2022-04-26 Impact factor: 4.241